Dysphagia – Diagnosis and Treatment

Diagnosis

A healthcare team usually begins diagnosing swallowing problems by talking to the patient about their symptoms. They ask about trouble swallowing, choking, coughing, or pain when swallowing.

They also review the patient’s medical history and perform a physical exam to look for signs of a swallowing disorder.

Several tests can help find the cause:

Barium X-Ray

The patient drinks a special liquid called barium, which coats the esophagus. Doctors then take X-rays to see the shape of the esophagus and how it works during swallowing.

Sometimes, the patient swallows a solid or pill with barium to help spot blockages or muscle problems.

Dynamic Swallowing Study

The team uses different foods coated with barium. They watch the motion of swallowing in real-time to check how the mouth, pharynx, and esophagus work together.

This study may reveal if food enters the airway or if muscles are weak.

Endoscopy

Doctors insert a thin, flexible tube with a camera, called an endoscope, to look inside the throat and esophagus. They can see swelling, narrowing, tumors, or other issues.

Doctors may take tissue samples, or biopsies, to check for inflammation or disease like eosinophilic esophagitis.

Fiber-Optic Endoscopic Evaluation of Swallowing (FEES)

A small camera goes in the nose so doctors can watch how the throat muscles work when the person swallows different textures. This test helps find out if food or liquid enters the windpipe by mistake.

Esophageal Manometry

Doctors use a small tube with sensors, passed through the nose and into the esophagus, to measure muscle strength and coordination. The tube records pressures as the patient swallows, helping to diagnose problems like weak or uncoordinated muscles.

Imaging Scans

CT and MRI scans provide detailed pictures of the throat and chest. These images can help find tumors, abnormal structures, or other problems affecting swallowing.

Signs and Symptoms Checked

Doctors check for several symptoms during these tests:

• Trouble starting to swallow
• Pain with swallowing (odynophagia)
• The feeling that food is stuck (globus sensation)
• Coughing or choking, especially when eating
• Regurgitation of undigested food
• Unintentional weight loss
• GERD symptoms like heartburn

Commonly Used Diagnostic Tools

Test Name	What It Checks	How It Helps
Barium Swallow	Structure and movement of the esophagus	Finds blockages, weak muscles
Dynamic Swallowing Study	Coordination of mouth and throat muscles	Finds aspiration, muscle problems
Endoscopy	Physical appearance of esophagus and throat	Detects inflammation, tumors, narrowing
FEES	Throat muscle movement and airway protection	Shows if food enters airway, muscle control
Manometry	Pressure levels in esophagus muscles	Identifies weakness, dysfunction
CT/MRI Scans	Detailed images of tissues and organs	Finds growths, swelling, structure problems

Areas Examined

Most tests focus on:

• The mouth and throat (pharynx)
• The esophagus

Doctors also check the lower esophageal sphincter and the airway for accidental inhalation of food or drink.

Testing helps tell the difference between problems caused by nerve or muscle diseases and those from blockages or injury.

Summary Table: Areas and Problems Checked

Area	Problem Checked	Example Test
Mouth/Throat	Trouble starting swallow, choking	Dynamic study, FEES
Esophagus	Blockage, narrowing, weak muscles	Barium swallow, manometry
Airway	Food or liquid entering windpipe	FEES, dynamic swallowing
Soft tissues	Tumors, abnormal growth, swelling	CT/MRI, endoscopy

A team including doctors, speech pathologists, and technicians often works together to test for swallowing disorders. The tests used depend on the person’s symptoms and the suspected problem.

Treatment

Handling Trouble Swallowing from Muscle or Nerve Issues

People with swallowing issues from problems in the mouth or throat, such as those caused by stroke, dementia, or Parkinson’s disease, often work with speech or swallowing therapists.

Therapy can include:

• Muscle Coordination Exercises: These exercises strengthen and improve the timing of the muscles used in swallowing.
• New Swallowing Techniques: Patients learn certain head and body positions or ways to place food in the mouth to help prevent choking and aspiration.

Therapists also teach safe eating habits to avoid silent aspiration, which can lead to lung infections.

Special tools like fiberoptic endoscopic evaluation of swallowing help study how food passes and whether food or liquid is being inhaled into the airways.

Managing Swallowing Problems in the Esophagus

Treatments for swallowing issues in the esophagus depend on the underlying cause.

Problem	Approach
Motility disorders/achalasia	Balloon dilation, myotomy procedures
Narrowing (strictures)	Esophageal dilation, stenting
GERD or acid reflux	Medications, special diets
Inflammation/eosinophilic esophagitis	Steroid medicines or diet changes
Tumors, structural problems	Surgery, stents

Doctors use endoscopy to insert a balloon or tube to gently stretch strictures, rings, or narrowed areas.

Patients with acid reflux or GERD often take medicines to lower stomach acid, such as proton pump inhibitors. If swelling is from eosinophilic esophagitis, doctors may prescribe steroid drugs.

Some people benefit from diet changes, especially if inflammation is a cause. If manometry or endoscopy shows ongoing motility problems, doctors may suggest more targeted treatments.

Addressing Serious Swallowing Disorders

When swallowing becomes so hard that eating and drinking are unsafe or cause weight loss, doctors may take extra steps.

A feeding tube, such as a gastrostomy or nasogastric tube, may be placed to provide nutrition directly into the stomach or intestine.

Blended or pureed foods and thickened liquids are sometimes recommended to reduce the risk of aspiration and pneumonia.

This approach is often used in severe cases related to advanced dementia, stroke, or after head and neck cancer treatment.

Surgical Procedures for Swallowing Problems

Some people need surgery for structural blockages, tumors, certain motility disorders, or complications from previous treatments.

Common surgical options include:

• Laparoscopic Heller Myotomy: Surgeons cut the lower esophageal sphincter muscle to help food pass into the stomach, especially for achalasia.
• Peroral Endoscopic Myotomy (POEM): Surgeons use an endoscope to reach the esophagus and cut the tight sphincter muscle in a less invasive way.
• Stent Placement: Doctors place a tube or stent made of metal or plastic to keep the esophagus open when there is a stricture or blockage.
• Botox Injections: Doctors inject onabotulinumtoxinA into the esophageal sphincter muscle to help it relax. This is often used for people who cannot have surgery or need temporary relief.

After surgery, therapists help patients regain swallowing function. Surgical choices depend on the patient’s health and the exact cause of dysphagia.

Everyday Steps and Care at Home

People can manage difficulty swallowing by making a few changes at home. Eating smaller meals more often may help prevent choking and reduce the risk of malnutrition.

Cutting food into small pieces, chewing well, and eating slowly can make swallowing safer and more comfortable. Trying foods with different textures can help find which are easier to swallow.

Some people have trouble with thin liquids like water or juice, while others may struggle with sticky foods such as peanut butter. Thicker liquids or softer foods are sometimes easier to manage.

Avoiding alcohol and caffeine can help because these can dry out the mouth and throat. Dryness can make swallowing hard and increase the risk of dehydration.

Keeping social interactions during meals positive helps lower the risk of feeling left out or isolated.

Problem	Helpful Action
Dehydration	Drink thickened fluids
Malnutrition	Eat small, frequent meals
Heartburn	Choose non-acidic foods
Xerostomia	Avoid alcohol/caffeine, stay hydrated
Social isolation	Eat meals with others

Getting Ready for Your Visit

Steps to Take Before Your Appointment

• Call Ahead: Ask if you need to prepare in any special way, such as not eating or drinking before your visit.
• Write Down Your Symptoms: Include everything you feel, even if some symptoms do not seem connected. Note when they started and how often they happen.
• Track Your Health History: Make a list of any big changes or stress in your life that might relate to your condition.
• List All Medicines and Supplements: Include the name and dose of each.
• Prepare questions for the healthcare provider or speech-language pathologist:
  • What could be causing the swallowing problem?
  • Are there other possible reasons for this?
  • What tests are needed?
  • Is the condition likely to last or get better?
  • Should any foods be avoided or changed?
• Organize your notes: Consider keeping a small notebook or using a mobile app. This may help you recall details during the appointment.

Questions Your Doctor or Specialist May Ask

The healthcare provider or speech-language pathologist may ask about:

• When did your swallowing trouble begin?
• Does it happen all the time or only some days?
• Are certain foods especially hard to swallow?
• Do you find it harder to swallow solids, liquids, or both?
• Have you coughed or gagged when eating or drinking?
• Have you lost any weight, or have you vomited?
• Do certain things make your symptoms better or worse?
• Do you ever bring up food after swallowing it?

Writing your answers before the visit can make things quicker and less stressful.